Thursday, July 22, 2010

Suboxone – Miracle or Menace?

I have recently been following a lively discussion on Linked-in with this title. Suboxone has now been available for a few years and we are all starting to now see many patients who are having serious problems with it.

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Suboxone is a powerful opiate (narcotic) that can be prescribed by physicians for patients who have opiate dependence problems. It can be used either for detoxification or for maintenance. The problem is we are now seeing that it can also be abused. Suboxone was approved in the US in 2000 and is now prescribed by many physicians thought the country. Last time I checked there were over 25 physicians just in Richmond Va. who are licensed to prescribe it. In 2009, Suboxone generated profits for the company of about $440 million.

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So it is a popular drug and it has become a very popular treatment option for patients. There are a number of reasons for this. Firstly, opiate addiction is a common problem. If you combine Heroin addiction with all of the people using opiate painkillers in a non- medical way, there are over 30 million people in the US affected by this disease. Secondly, standard treatments are not very effective. Opiates are extremely powerful. It is very difficult for patients to detoxify off them. And if patients are able to get off opiates, it is even more difficult to stay off them. Opiates go straight to the pleasure center and people feel so good being on them and they feel so awful when they don’t have them. So without help most patients relapse back to opiate use pretty quickly.

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Suboxone is very powerful and can be useful because of its two unique properties. Firstly it binds very tightly to the opiate receptors, and secondly it only turns the receptor on partially. Because it binds so tightly to the receptors it lasts a very long time, and it has a kind of blocking effect. That is, if someone is on Suboxone and they try to use Heroin or OxyContin, they only get a small effect because most of the receptors are already occupied. This is good because the whole idea is to stop patients from using street drugs. Because it only turns the switch on partially Suboxone doesn’t produce a dramatic high. This is good because we don’t want the drug we are switching patients to, to be even more pleasurable than the one they were on.

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But there are two major problems with Suboxone. Firstly, it does turn the receptor on (so it is highly addictive), and secondly it lasts a very very long time (which means the withdrawal off it takes a very long time). This means it is highly addictive and the withdrawal off Suboxone is very unpleasant and lasts much longer than the withdrawal off Heroin or OxyContin. Patients usually only find out about this when they want to come off their Suboxone.

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Other problems with Suboxone are starting to rapidly mount up. Many people are abusing the Suboxone itself. There are reports from all over the world of patients abusing Buprenorphine (the active ingredient in Suboxone). Many are reports of people abusing Buprenorphine intravenously or snorting it. Often it is combined with Benzodiazepines. According to DAWN data from 2006 there were over 4,400 ER visits associated with Buprenorphine.

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The most common problem we and other clinicians are hearing about is that a lot of opiate addicts are using Suboxone illegally when they can’t get their Heroin or other opiates. They continue to use street drugs to get high, and then use Suboxone to avoid withdrawal. Suboxone is a lot cheaper than street drugs so patients will use it to avoid withdrawal when they can’t afford their regular drug. Many patients are getting a prescription for Suboxone and their only intention is to sell or swap the Suboxone for more “pleasurable” drugs. Patients tell me that it’s been very easy to see their physician every month and keep getting their Suboxone prescription. They just have to make sure they don’t use street drugs before their appointment in case the physician gets a drug screen.

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Other people who are hooked on street drugs are using Suboxone before they have to provide a drug screen – if they are going for a job interview for example. Suboxone will only be picked up with specialized drug screen, although this is starting to change.

So, it seems pretty clear that Suboxone is not any kind of magic bullet – for most people it is not an “easier, softer way”.

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We believe that for most people the combination of our Accelerated Opiate Detox and Naltrexone Implants is the best solution. The detox helps patients quickly get off their drugs in a safe and comfortable way. The Naltrexone implants give them the support they need to deal with cravings and allow them to get into real recovery. It is not an easier softer way, but it brings the happiness and peace that people really crave.

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For patients who are hooked on Suboxone, our Accelerated detox program is able to get hem fully detoxed in about 8 days.

8 comments:

Thank you for this article. I have been on Oxycontin and Suboxone and I have been rapidly detoxed at the Coleman Institute and I can agree with this article 100%. I have also used the Vivitrol shot after being detoxed to help me through the rough months after detox. I now have two years clean and have not had any naltrexone (vivitrol) for seven months. I feel wonderful. Thank you Dr. Coleman and all of your staff for the wonderful things you do for all of your patients. I love all of you.

I absolutely agree with you. I have a non profit corp. called "P.A.I.N.", Prescription Abusers In Need in Fresno, Ca. I had a 20 yr. addiction to opiates and got clean in 2001. We have found that the 18-25 year old can't get off the Suboxone. We have Dr's prescribing it like it's candy and the kids are selling it & using it when they are out of oxycontin.

I am on 8mg daily of sub, will be on it for life. My doc says I do not need to ever stop taking it. You either have the wrong doctor, go to a better one, to get a permanent lifetime prescription. OR you were caught doing something wrong with your subs.

dr coleman i have been sturgleling o get off methadone im currently taking aout 10 ml and i dont have insurance i have to buy it from a friend but im just truly very tired of all this bull but the truth is that i have a fear of letting it go i have been a heroine addict for over 27 yrs now i wish that some how some way someone in the proffesion would help me get thru thisfear of mine see i have kicked methadone and heroine several times but in jail always but never out on the streets im looking for help here please someone help me im truly crying inside i wish that a proffesional would take me under their wing and help me as a sad case thats feels sorry for me but ii also understand that all theese drs and proffesionals look at their jobs as for profit they work for money and thats something that i lack all i spend is 20 dollars a week on methadone for 60 ml per week or so im un employed and tired of being in this position because of the kicking that i have to go thru its like i have a phobia or even maybey have been traumatized but im really in a sad position in life after all theese word that i have opened up to i wish and pray that someone hears my plea i live in stockton california my name is jaime infante and im 45 yrs old and just became a grampa for the 2nd time please dr oor any proffesional give me a call 1 209 234 8497 that im stuck in a position in life that i dont like living this way any more im stuck and tired god bleess my wife that shes still with me after all theese years and i know that this is very rare because she does not use any type of drugs at all sometimes i wonder what is my purpose in this life what is my role? well i hope that somebody that is in a better position that i will hear me i dont want money i wanna get cured from this disease thank you for your time hope someone is listening tonight thanks jaime infante in the san francisco bay area thanks again til i see a new horizone

It's extremely sad to see someone give up on themselves to the point that they'll willingly be on maintenance til the day they die.

I'm on 8mg, and am presently trying to find a detox in my city that will let me detox off this dose so I can then switch to vivitrol injections.

Unfortunately, the suboxone isn't "holding" me - even at doses of 12 & 16mgs. This is probably because of one of my psych medications accelerating my metabolism of buprenorphine. So while the Suboxone is giving my addiction its daily "fill", my metabolism rips the plate away from it too soon (usually in the early evening). Lately I've been having the odd lapse during these periods of craving.

It doesn't seem like any detox centre is that sympathetic to my cause either. In my country (Australia), most detoxes try to get their patients ..on maintenance.. , and here I am asking them to help me get off it.

Why are Doctors changing people to this drug, I need a hip replacement, (just had my left side done) Need my right side done (Hip), need a knee replacement on left knee and have severe arthritis in my right knee, have had 2 back surgeries, I am on Morphine sulfate and a low dose of Oxycodone, have been on the same dose for 3 yrs. and it covers my pain, now my Doc. is all over this Suboxone???? Why change what is working, I don't get high on the meds., Use correctly, why not leave things alone, I don't believe from what I'm reading that it helps u, at all!! IT'S LIKE PUTTING SOMEONE ON A DESIGNER methadone, TO ME!!

I read all of this and it makes me want to cry, literally.. I have been struggling thru the curse of addiction for years now and it's just a never ending cycle.. I thought I had found some normalcy with suboxone.. I thought I would be on it for a while and then get off.. Here I am 3 years later at 28 yes old begging god every day to save me before I collapse for good.. I had a good dr when I was living in Indiana and I was forced literally to come back to Pa.. Now I'm sitting here on about 80 mg of oxy ready to blow my head off just thinking about what's going to happen next.. I would love to find a good dr and ween down from the subs and get off for good.. But suboxone is a money game obviously.. And ya, when u don't have the money ur pretty much just f'd.. No place will help.. What's wrong with our society..?! People who genuinely are sick of the suboxone runaround .. Against the people who run en and sell en. Ha! All money that's all I see.. U got it or u don't.. If anyone figures it out god I'm ready for this to end but it's so hard!! Way harder than the dope ever was.. I'm down to the end of my rope.. I'm scared and I don't know what to do anymore.. I'm living in sandy lake pa, moochin oxy of my Ma, and wishing for change.. I havnt taken a sub in over a week now but what good is it when I'm just substituting? And doing a terrible job of it at that?! I'm a junkie but god knows I don't want to be.. Its so hard for me to "pace" myself on what's really my drugs of choice.. I can't afford a sub dr around here they all want large amounts of cash to see some one!! WTF has it come too?! I can buy drugs cheaper than see the dr.. Jpeidle83@yahoo.com that's my email and just another one begging for help.. The subs just made it worse and now nothing fills there place.. I wish I never started on them but I did and now here I am.. Down to the end. Afraid...

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The Coleman Institute, the Advanced Center for Addiction Treatment, is recognized as one of the most successful and innovative outpatient accelerated detox centers for addiction treatment in the country with 10 offices in the U.S.
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